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Clinical Case Report: Efficacy of Yogic Techniques in the Treatment of Obsessive Compulsive D Isorders

DOI:10.3109/00207459608986347
Authors:
David Shannahoff-Khalsa at University of California, San Diego
David Shannahoff-Khalsa
Liana R. Beckett
Liana R. Beckett
Liana R. Beckett
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Abstract

The aim of this study was to investigate the clinical efficacy of yogic techniques in the treatment of eight adults with obsessive-compulsive disorder (OCD). A specific yogic breathing pattern has been prescribed for the treatment of OCD, as well as others for treating generalized anxiety. A one year course of therapy was followed. Subjects improved on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) comparing baseline with three, six, nine, & 12 month results (one-way ANOVA for repeated measures, F(4, 12) = 3.343, p
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Int J Neurosci 1996 Shannahoff-Khalsa and Becket_Clinical Case Report_Efficacy of Yogic Techinques in the Treatment of Obsessive Compulsive Dis
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... Here we address how Kundalini Yoga (KY) meditation techniques have been tested previously in an 11-part "OCDspecific" protocol that includes eight primary techniques and three optional techniques (12,13). Two studies have examined the efficacy of this protocol in treating OCD: one open uncontrolled trial (12) and a randomized controlled trial (RCT) comparing the KY meditation protocol against Relaxation Response (RR) plus the Mindfulness Meditation (13). ...
... Here we address how Kundalini Yoga (KY) meditation techniques have been tested previously in an 11-part "OCDspecific" protocol that includes eight primary techniques and three optional techniques (12,13). Two studies have examined the efficacy of this protocol in treating OCD: one open uncontrolled trial (12) and a randomized controlled trial (RCT) comparing the KY meditation protocol against Relaxation Response (RR) plus the Mindfulness Meditation (13). The 12-month open pilot trial (12) started with eight patients (seven females), with a Y-BOCS baseline mean of 21.125 (SD +4.32). ...
... Two studies have examined the efficacy of this protocol in treating OCD: one open uncontrolled trial (12) and a randomized controlled trial (RCT) comparing the KY meditation protocol against Relaxation Response (RR) plus the Mindfulness Meditation (13). The 12-month open pilot trial (12) started with eight patients (seven females), with a Y-BOCS baseline mean of 21.125 (SD +4.32). Five patients were medicated, and their medications were stable for >3 months prior to entry. ...
Kundalini Yoga Meditation Versus the Relaxation Response Meditation for Treating Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial
Article
Full-text available
  • Nov 2019
Background: Obsessive-compulsive disorder (OCD) is often a life-long disorder with high psychosocial impairment. Serotonin reuptake inhibitors (SRIs) are the only FDA approved drugs, and approximately 50% of patients are non-responders when using a criterion of 25% to 35% improvement with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). About 30% are non-responders to combined first-line therapies (SRIs and exposure and response prevention). Previous research (one open, one randomized clinical trial) has demonstrated that Kundalini Yoga (KY) meditation can lead to an improvement in symptoms of obsessive-compulsive severity. We expand here with a larger trial. Design: This trial compared two parallel run groups [KY vs. Relaxation Response meditation (RR)]. Patients were randomly allocated based on gender and Y-BOCS scores. They were told two different (unnamed) types of meditation would be compared, and informed if one showed greater benefits, the groups would merge for 12 months using the more effective intervention. Raters were blind in Phase One (0–4.5 months) to patient assignments, but not in Phase Two. Main Outcome Measures: Primary outcome variable, clinician-administered Y-BOCS. Secondary scales: Dimensional Yale-Brown Obsessive Compulsive Scale (clinician-administered), Profile of Mood Scales, Beck Anxiety Inventory, Beck Depression Inventory, Clinical Global Impression, Short Form 36 Health Survey. Results: Phase One: Baseline Y-BOCS scores: KY mean = 26.46 (SD 5.124; N = 24), RR mean = 26.79 (SD = 4.578; N = 24). An intent-to-treat analysis with the last observation carried forward for dropouts showed statistically greater improvement with KY compared to RR on the Y-BOCS, and statistically greater improvement on five of six secondary measures. For completers, the Y-BOCS showed 40.4% improvement for KY (N = 16), 17.9% for RR (N = 11); 31.3% in KY were judged to be in remission compared to 9.1% in RR. KY completers showed greater improvement on five of six secondary measures. At the end of Phase Two (12 months), patients, drawn from the initial groups, who elected to receive KY continued to show improvement in their Y-BOCS scores. Conclusion: KY shows promise as an add-on option for OCD patients unresponsive to first line therapies. Future studies will establish KY’s relative efficacy compared to Exposure and Response Prevention and/or medications, and the most effective treatment schedule. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01833442.
... One small open-label pilot study and two randomized controlled trials (RCTs) on its effects in OCD have been published. [9][10][11] KY was evidenced to have beneficial effects on patients with OCD in all of the studies. In the former, five patients completed the 12-month trial, showing significant positive outcome in their clinical symptoms and severity. ...
... Though all of them had improved on fluoxetine, an SSRI, for at least 3 months prior to this study, it was seen that dose reduction and cessation of the medicine were possible in them after incorporation of the Yoga practice. 9 One RCT by Shannahoff-Khalsa et al. showed that KY was more effective as a monotherapy or adjunct to pharmacotherapy as compared to relaxation response and mindfulness meditation techniques. 10 Each group had seven participants who were given the particular mode of treatment for 3 months. ...
The science and art of yoga in mental and neurological healthcare.
Book
  • Dec 2020
Clinical treatment as Yoga on mental and neurological healthcare is a text on mechanism of yoga in treating mental and neurological health issue through understanding the science of Yoga
... [14][15][16][17] KY has already shown efficacy in OCD. [18][19][20] Other forms of yoga such as Sudarshankriya have been found to be beneficial in depression. [21] Yoga has also been found to be helpful in improving sleep in patients with minimal cognitive impairment. ...
... Our quasi-experimental study has explicitly demonstrated the therapeutic benefits of Rajyoga mediation in OCD over pharmacological management alone. While the therapeutic effectiveness of yoga in OCD has been demonstrated in various studies, [18][19][20][28][29][30] the literature in this regard is sparse from India. [31,32] We used DSM-5 criteria for including patients in our study as compared to a study by Bhat et al. [31] who used DSM-IV criteria. ...
Effectiveness of Rajyoga meditation as an adjunct to first-line treatment in patients with obsessive compulsive disorder
Article
Background: Yoga is a set of mental, physical, and spiritual practices with its origin in ancient India. The renewed interest in Yoga has led to the exploration of its benefits in a variety of psychiatric disorders such as schizophrenia, depression, and anxiety disorders. There is a dearth of literature on the effect of yoga in obsessive compulsive disorder (OCD) in the Indian context. Aim: The present study was conducted to find out the efficacy of Rajyoga meditation (RM) as an adjunct to the first-line treatment in the treatment of OCD. Materials and methods: Patients with OCD (diagnosed according to Diagnostic and Statistical Manual of Mental Disorders fifth edition) were divided into two groups - (i) The meditation group (MG), which included 28 patients and (ii) The nonmeditative group (NMG), which included 22 patients. MG practiced RM protocol for 3 months duration in addition to the pharmacological treatment. The NMG continued on pharmacological management as usual. The symptomatology was assessed at baseline and 3 months using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Results: At 3 months, both groups demonstrated improvement in symptoms. The improvement in MG was statistically significant with a change of 9.0 ± 3.16 in Y-BOCS and a 49.76 ± 9.52% reduction in symptoms. Improvement scores of NMG were also statistically significant with a change of 3.13 ± 2.59 in Y-BOCS and 18.09 ± 14.69% reduction in symptoms. MG showed significantly more improvement in Y-BOCS scores (49.76 ± 9.52) as compared to NMG (18.09 ± 14.69) using the student's paired t-test (P < 0.001). Conclusion: The present study suggests that the RM is an effective adjunctive therapy to reduce obsessions and compulsions in patients with OCD.
... For example, a study of women practicing Iyengar yoga twice weekly for 8 weeks found significant decreases in anxiety levels, as well as significant improvements in overall well-being (Michalsen et al., 2005). In another study, individuals diagnosed with Obsessive-Compulsive Disorder also demonstrated significant decreases in anxious distress following a 12-month yoga intervention (Shannahoff- Khalsa & Beckett, 1996). Valoriani et al. (2014) found significant reduction in self-reported distress and decreased levels of depression among women seeking in vitro fertilization treatments following a hatha yoga intervention as part of psychological support. ...
... Regardless of instructor or severity of psychological symptoms, clients reported experiencing a positive impact of the yoga intervention on symptoms of anxiety. Results are comparable to previous literature reporting a positive impact of yoga-based practices on experienced anxiety (Anderson, Mammen, Paul, Pletch, & Pulia, 2017;Michalsen et al., 2005;Shannahoff-Khalsa & Beckett, 1996). Contrarily, whereas previous research has demonstrated decreased anxiety in longitudinal studies with repeated interventions and measures (Li & Goldsmith, 2012), the present study evidenced immediate impacts on selfreported state anxiety. ...
Psychotherapeutic yoga demonstrates immediate positive effects.
Article
Full-text available
  • Sep 2018
Although various yoga practices (YBPs) have existed for centuries as a self-proclaimed system of healing (Khalsa, 2007; Saraswati, 2011), YBPs have only recently been increasingly integrated into Western models of healing and well-being. Clinical practices are increasingly incorporating elements of mindfulness in philosophies and treatments (e.g., Hayes, Srosahl, & Wilson, 1999; Linehan, 1993; Brach, 2003) and reporting that improved mindfulness leads to positive mental health outcomes (Kiken, Garland, Bluth, Palsson, & Gaylord, 2015). Research on effectiveness of YBPs has reported variable results (Jeter, Slutsky, Singh, & Khalsa, 2015; Büssing, Michalsen, Khalsa, Telles, & Sherman, 2012), but there is some evidence of reduced anxiety (Michalsen et al., 2005; Valoriani et al., 2014) and depression (Kinser, Bourguignon, Whaley, Hauenstein, & Taylor, 2013). The study described herein sought to more rigorously explore outcomes of psychological well-being immediately following a psychotherapeutic yoga class. Findings revealed that a single session of psychotherapeutic yoga decreased anxiety and increased subjective well-being, even after controlling for therapist variability, prior yoga experience, and client diagnosis. This is the first study to examine outcomes of an ongoing YBP in the naturalistic setting of an outpatient counseling center while rigorously controlling for confounding factors (e.g., therapist variability).
... Yoga which encompasses several techniques including physical postures, breathing techniques (Pranayama), and meditation has become very popular for its applications in health starting from better physical fitness (Telles, Hanumanthaiah, & Nagarathna, 1994). Several studies have highlighted the psychological benefits of integrated Yoga practices such as anxiety and neurosis (Brown, & Gerbarg, 2005;Shannahoff-Khalsa, & Beckett, 1996). Hence, the objective of the present investigation was to study the efficacy of group yogic practice (GYP) and individual yogic practices (IYP) on LS in male adults. ...
Evidence-based comparative study of group and individual consciousness on life satisfaction among adults
Article
  • Jun 2020
Background: Life satisfaction (LS) is the method during which people show their emotions, feelings (moods), and the way they feel concerning their directions and choices for the longer term. It is a measure of well-being assessed in terms of mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to address one’s lifestyle. LS involves a good angle toward one’s life instead of an assessment of the current feelings. LS has been measured in relation to economic standing, degree of education, experiences, residence, and many other topics. Objective: The objective of the present study was to see the effect of group yoga and individual yoga training on LS among adults. Materials and Methods: In the present study, 100 college students and employees aged 18–45 years with dissatisfaction were randomized into two groups, that is, group yoga practice (GYP, n = 50) and individual yoga practice (n = 50). All the participants were assessed for LS using a standard questionnaire at the baseline and after completion of 45 days of training intervention. Data analysis was done using statistical software SPSS Version 23.0. Data were analyzed using paired t-tests. Results: The results showed that LS in GYP improved statistically significantly (t = 3.20, p < 0.01) after 45 days of yoga intervention. Further, in the case of the individual yoga practice group, the results showed that there was no statistically significant increase (t = 1.94, p > 0.05) in LS of the participants. Conclusion: Group yoga intervention is effective in increasing LS among adults as compared to individual yoga intervention.
... Following promotes nature in person thereby control mind and body. means controlling technique of breath; by controlling of breath one can also control his mind It appears to be superior to no treatment and progressive relaxation and reduction in symptoms for both depression and anxiety [38,39,40,41] It shows good safety and tolerability in short-term treatment [42]. Rodenback, (1999) and Miyard, (2002) conclude that significantly reduce stress and anxiety after one month practice. ...
Case Report Management of Obsessive Compulsive Disorder (OCD) Through Ayurveda
Article
Full-text available
  • Jan 2019
Introduction: Aim Material and method Observation and result Conclusion: Keywords: Obsessive compulsive disorder (OCD) is a co-morbid condition of psychiatric disorders such as anxiety and depression. It is characterized by obsessions of contamination, followed bywashing or accompanied by compulsive avoidance of the presumably contaminated object orObsession of doubt, followed by a Compulsion of Checking and intrusive obsession of thoughts without a compulsion. There is a vast array ofAyurveda which can potentially add value in management of such type . OCD can be compared to and various types of as described inAyurveda texts. treatment is great boon toAyurveda. By collaborative use of , treatment and showed encouraging results in case study ofOCD. :To study efficacy of treatment in themanagement ofOCD. : 26 years old female patient with history of recurrent washing and cleaning her hands, unexplained fear, insomnia and depression attended the OPD. with decoction was administered, prior to that oleation with Cow ghee was given. After following diet regime, palliative treatment started with and treatment, Spiritual therapy like recitation by using basic principles to break pathophysiology ofOCD : The patient got relief in unexplained fear with appreciable recovery in Insomnia, decreased habit of recurrentwashing hands andDepression. ConservativemanagementwithAyurveda principle provides significant relief in unexplained fear and anxiety, feeling of apprehension and fear, Insomnia, worry and. Feeling of uncertainty, anorexia, weight loss and improvement in quality of life of patient.
Psycho-Spirituality-A trigger for thought transformation
Article
Full-text available
  • May 2020
The whole idea of Psycho-Spirituality as we see it, is to transcend what's wiped out a psychological approach, to transcend what seems to be psychological. The psychological aspect of it's just something to affect clearing away the clutter to urge to the purpose where we will reach the spiritual truth, and realize that it's already happened, it's already there. It seems that we expect about what appears to be a psychological issue, it seems that we do techniques that revolve around it, but really, it's about connecting first at a deeper level, keeping that in mind while we are browsing the opposite aspects of it. That's the spiritual aspect that permeates the entire process. regardless of what it's like that we do in form, we are still always returning to the joining with the Spirit, truth Self, joining with the reality of what we are. Whereas psychology deals with duality and helps make duality better and more tolerable, with Psycho-Spirituality we focus of the pure truth of Oneness after we are handling the thought of the illusion of separateness. At the level, truth Self level, there's nothing to try to do but to simply accept Oneness. But in form, we apply these psychospiritual techniques to facilitate the furtherance of the acceptance of the spiritual aspect. Acceptance is simpler once we dig through the debris (Negativity) of the mind that obscures the validity of the essence of our being. Just merely stating the reality does help the people sometimes, but sometimes, taking a lively stance and energy towards digging through the lies of the illusion can help facilitate the acceptance of Oneness. The focus of this approach is basically Oneness, but the psychological aspect is put in commission of realizing the oneness of what we are, and since it's put in commission of it with the energy the force and therefore the will of Oneness behind it, it's not like regular psychology, it's not even close. We're performing from the opposite side of it, we aren't standing on the side of duality, working back and hoping to urge to Oneness. We stand on the side of Oneness, undoing the thought and therefore the effects of duality, approaching it from the other side, due to the very nature of how we do it. Psychology attempts to try to do something; what we do is not any attempt, it's coming from an area of truth that's not speculative. There's no argument: Oneness is Oneness. that's where we are coming from, and that we are helping the mind, the aspects of our mind that appear as if people, to understand that there are not any people, to figure through the imaginary problems. rather than being totally fixated inside the matter, we do what Einstein talked about, we are getting to a special level to unravel the imaginary problem. It's beautiful and stylish in its idea and its approach, and it doesn't require anybody to believe the methodology of it, it just works because it cannot not work, because it's what it's. Eventually, the mind is pulled out of the illusion, and that we proceed from there.
Yoga and Traditional Healing Methods in Mental Health
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Yoga and Traditional Healing Methods in Mental Health
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Yoga-Preksha-Dhyan Practice As A Cost-Effective Preventive Strategy Against Aggressiveness In Primary School Children
Article
Full-text available
  • Jul 2017
Increasing aggressiveness in adolescents and youth throughout the world has become a global public health issueinvolving huge psychological, social and economic costs. High aggressiveness in children has been observed very often to develop into conduct disorders, antisocial activities, and juvenile delinquency. Therefore, it is important to identify children with tendencies of high aggressiveness at an early age and todevelop cost-effective preventive strategies, which can be implemented on a large-scale. Our previous pilot studies on primary school children in a model municipal school in New Delhi showed a significant reduction in aggressiveness after administration of a yoga-preksha-dhyan ((YPD) intervention module, specially developed for children (Jain et al., 2014). We have, therefore, undertaken further investigations on larger number of subjects from multiple schools to assess reproducibility and generalizability. The present study was conducted on 2080 elementary school students of IIIrd to Vth class (Age; 7-14 years, average 9.3+1.7yrs) from 5 South Delhi Municipal Corporation schools. 330 highly aggressive students (Boys: 181; Girls: 149) were identified on the basis of scores obtained using a validated and reliable Self-Report Questionnaire which also distinguishes proactive aggression (PA) from reactive aggression (RA). Themulti-modal YPD moduleconsisting of asanas, pranayama andpreksha-dhyan components, was administered to students with high Overall aggressiveness Scores (OA-Score) for 36 sessions (45 minutes/session, 3 days/week). Aggressiveness was assessed by the self-report questionnaire pre and post-YPD intervention. The results show that, after the intervention theOA-, PA-and RA-Scores of students reduced considerably. The average pre-YPD OA-Scores (44.26+6.5) decreasedto OA-Score (30.40+8.3) post-YPD, which is statistically highly significant (p-value = 0.001). The results are in agreement with our previous pilot study, confirming that YPD practicecould be a cost-effective preventive intervention against the development of conduct disorders, antisocial behaviors and violent crimes. Since it is relatively easy to implement, the introduction of YPD program on large scale in schools, could lead to a more peaceful society in future. Further research is therefore warranted.
The obsessive-compulsive syndrome
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Epidemiology and clinical features of obsessive-compulsive disorder
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During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.
Changes in blood glucose levels induced by differential forced unilateral nostril breathing, a technique which affects both brain hemisphericity and autonomic activity
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Local Cerebral Glucose Metabolic Rates in Obsessive-Compulsive Disorder
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• We studied 14 patients with obsessive-compulsive disorder (OCD) by positron emission tomography and the fluorodeoxyglucose method, looking for abnormalities in local cerebral metabolic rates for glucose in brain structures that have been hypothesized to function abnormally in OCD.These patients were compared with 14 normal controls and 14 patients with unipolar depression. The patients with unipolar depression and OCD did not differ in levels of anxiety, tension, or depression. In OCD, metabolic rates were significantly increased in the left orbital gyrus and bilaterally in the caudate nuclei. This was apparent on all statistical comparisons with both controls and unipolar depression. The right orbital gyrus showed at least a trend to an increased metabolic rate in all comparisons. The metabolic rate in the left orbital gyrus, relative to that in the ipsilateral hemisphere (orbital gyrus/ hemisphere ratio), was significantly elevated compared to controls and subjects with unipolar depression, and stayed high even with successful drug treatment. Though it was in the normal range in the morbid state, with improvement in OCD symptoms after drug treatment, the caudate/hemisphere metabolic ratio increased uniformly and significantly bilaterally. This ratio did not increase in patients who did not respond to treatment. Thus, OCD showed cerebral glucose metabolic patterns that differed from controls in both the symptomatic and recovered states.
Focal Striatal Abnormalities in a Patient With Obsessive-Compulsive Disorder
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A young man with obsessive-compulsive disorder is described who was found on magnetic resonance imaging to have unilateral left-sided abnormalities in the head of the caudate nucleus and putamen, and a discussion of the possible role of the striatum in obsessive-compulsive disorder is presented.
A Double-blind Desipramine Substitution During Long-term Clomipramine Treatment in Children and Adolescents With Obsessive-Compulsive Disorder
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• Twenty-six chilndren and adolescents with severe primary obsessive-compulsive disorder receiving long-term clomipramine hydrochloride maintenance treatment (mean±SD, 17.1±8.3 months; range, 4 to 32 months) entered an 8-month double-blind desipramine hydrochloride substitution study to assess the necessity of continued drug treatment. All patients received clomipramine for the first 3 months, then half continued with clomipramine therapy (nonsubstituted group) and half had desipramine blindly substituted for the next 2 months; all subjects again received clomipramine for the last 3 study months. Eight (89%) of nine of the substituted and only two (18%) of 11 of the nonsubstituted group subjects relapsed during the 2-month comparison period. Long-term clomipramine treatment seems necessary for this population of children and adolescents with obsessive-compulsive disorder. However, even patients receiving maintenance clomipramine treatment throughout the entire study had continued obsessivecompulsive symptoms, which varied in severity over time.
Caudate Glucose Metabolic Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder
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• We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessivecompulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/ hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessivecompulsive disorder symptoms.
Cerebral Glucose Metabolism in Childhood-Onset Obsessive-Compulsive Disorder
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• To investigate the effects of drug treatment in childhoodonset obsessive-compulsive disorder (OCD), we repeated positron emission tomographic scans in 13 adults with OCD (eight taking clomipramine, two taking fluoxetine, and three taking no drug) after at least 1 year of pharmacotherapy. As a group, the patients had a significant improvement on all OCD and anxiety ratings. Positron emission tomography revealed a significant decrease in normalized orbitofrontal regional cerebral glucose metabolism (relative to global metabolism) bilaterally. Among the treated patients, the decrease in right orbitofrontal metabolism was directly correlated with two measures of OCD improvement. These results extend previous positron emission tomographic findings of regional dysfunction in OCD and suggest involvement of the orbitofrontal regions in the pathophysiology of OCD.
Obsessive–Compulsive Symptoms in Neurologic Disease: A Review
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Obsessive-compulsive disorder (OCD) is an increasingly recognized disorder with a prevalence of 2-3% (Robins et al., 1984). Once thought to be psychodynamic in origin, OCD is now generally recognized as having a neurobiological cause. Although the exact pathophysiology of OCD in its pure form remains unknown, there are numerous reports of obsessive-compulsive symptoms arising in the setting of known neurological disease. In this paper, we review the reported cases of obsessive-compulsive symptoms associated with neurologic diseases and outline the known facts about the underlying neurobiology of OCD. Finally, we synthesize these findings into a proposed theory of the pathophysiology of OCD, in both its pure form and when it accompanies other neurological illness.